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Review
. 2016 Sep 20;9(9):CD007851.
doi: 10.1002/14651858.CD007851.pub3.

Intravenous alpha-1 antitrypsin augmentation therapy for treating patients with alpha-1 antitrypsin deficiency and lung disease

Peter C Gøtzsche  1 , Helle Krogh Johansen
Affiliations
Review

Intravenous alpha-1 antitrypsin augmentation therapy for treating patients with alpha-1 antitrypsin deficiency and lung disease

Peter C Gøtzsche et al. Cochrane Database Syst Rev. .

Abstract

Background: Alpha-1 antitrypsin deficiency is an inherited disorder that can cause chronic obstructive pulmonary disease (COPD). People who smoke are more seriously affected and have a greater risk of dying from the disease. Therefore, the primary treatment is to help people give up smoking. There are now also preparations available that contain alpha-1 antitrypsin, but it is uncertain what their clinical effect is.

Objectives: To review the benefits and harms of augmentation therapy with intravenous alpha-1 antitrypsin in patients with alpha-1 antitrypsin deficiency and lung disease.

Search methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed and ClinicalTrials.gov to 25 March 2016.

Selection criteria: We included randomised trials of augmentation therapy with alpha-1 antitrypsin compared with placebo or no treatment.

Data collection and analysis: The two review authors independently selected trials, extracted outcome data and assessed the risk of bias.

Main results: We included three trials (283 participants in the analyses) that ran for two to three years. All participants were ex- or never-smokers and had genetic variants that carried a high risk of developing COPD. Only one trial reported mortality data (one person of 93 died in the treatment group and three of 87 died in the placebo group). There was no information on harms in the oldest trial. Another trial reported serious adverse events in 10 participants in the treatment group and 18 participants in the placebo group. In the most recent trial, serious adverse events occurred in 28 participants in each group. None of the trials reported mean number of lung infections or hospital admissions. In the two trials that reported exacerbations, there were more exacerbations in the treatment group than in the placebo group, but the results of both trials included the possibility of no difference. Quality of life was similar in the two groups. Forced expiratory volume in one second (FEV1) deteriorated more in participants in the treatment group than in the placebo group but the confidence interval (CI) included no difference (standardised mean difference -0.19, 95% CI -0.42 to 0.05; P = 0.12). For carbon monoxide diffusion, the difference was -0.11 mmol/minute/kPa (95% CI -0.35 to 0.12; P = 0.34). Lung density measured by computer tomography (CT) scan deteriorated significantly less in the treatment group than in the placebo group (mean difference (MD) 0.86 g/L, 95% CI 0.31 to 1.42; P = 0.002). Several secondary outcomes were unreported in the largest and most recent trial whose authors had numerous financial conflicts of interest.

Authors' conclusions: This review update added one new study and 143 new participants, but the conclusions remain unchanged. Due to sparse data, we could not arrive at a conclusion about the impact of augmentation therapy on mortality, exacerbations, lung infections, hospital admission and quality of life, and there was uncertainty about possible harms. Therefore, it is our opinion that augmentation therapy with alpha-1 antitrypsin cannot be recommended.

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Conflict of interest statement

We have no conflicts of interest.

Figures

1
1
Study flow diagram.
2
2
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1 Alpha‐1 antitrypsin versus placebo, Outcome 1 Forced expiratory volume in 1 second (FEV1), change (mL or %).
1.2
1.2. Analysis
Comparison 1 Alpha‐1 antitrypsin versus placebo, Outcome 2 Carbon monoxide diffusion, change (mmol/minute/kPa or %).
1.3
1.3. Analysis
Comparison 1 Alpha‐1 antitrypsin versus placebo, Outcome 3 Computer tomography (CT) lung density, change (g/L).
See this image and copyright information in PMC

Update of

References

References to studies included in this review

Chapman 2015 {published data only}
    1. Chapman KR, Burdon JG, Piitulainen E, Sandhaus RA, Seersholm N, Stocks JM, et al. Intravenous augmentation treatment and lung density in severe α1 antitrypsin deficiency (RAPID): a randomised, double‐blind, placebo‐controlled trial. Lancet 2015;386:360‐8. - PubMed
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